Notched apparatus for guidance of an insertable instrument along an axis during spinal surgery

ABSTRACT

Described herein is a surgical instrument guide for use with a robotic surgical system, for example, during spinal surgery. In certain embodiments, the guide is attached to or is part of an end effector of a robotic arm, and provides a rigid structure that allows for precise preparation of patient tissue (e.g., preparation of a pedicle) by drilling, tapping, or other manipulation, as well as precise placement of a screw in a drilled hole or affixation of a prosthetic or implant in a prepared patient situation.

RELATED APPLICATIONS

The present application is a continuation of U.S. application Ser. No.14/597,883, filed Jan. 15, 2015, which claims priority to U.S.Provisional Application No. 61/927,894, filed Jan. 15, 2014; U.S.Provisional Application No. 61/935,281, filed Feb. 3, 2014; and U.S.Provisional Application No. 61/953,609, filed Mar. 14, 2014, thecontents of each of which are hereby incorporated by reference in theirentireties.

BACKGROUND

Robotic-assisted surgical systems have been developed to improvesurgical precision and enable the implementation of new surgicalprocedures. For example, robotic systems have been developed to sense asurgeon's hand movements and translate them to scaled-downmicro-movements and filter out unintentional tremors for precisemicrosurgical techniques in organ transplants, reconstructions, andminimally invasive surgeries. Other robotic systems are directed totelemanipulation of surgical tools such that the surgeon does not haveto be present in the operating room, thereby facilitating remotesurgery. Feedback-controlled robotic systems have also been developed toprovide smoother manipulation of a surgical tool during a procedure thancould be achieved by an unaided surgeon.

However, widespread acceptance of robotic systems by surgeons andhospitals is limited for a variety of reasons. Current systems areexpensive to own and maintain. They often require extensive preoperativesurgical planning prior to use, and they extend the required preparationtime in the operating room. They are physically intrusive, possiblyobscuring portions of a surgeons field of view and blocking certainareas around the operating table, such that a surgeon and/or surgicalassistants are relegated to one side of the operating table. Currentsystems may also be non-intuitive or otherwise cumbersome to use,particularly for surgeons who have developed a special skill or “feel”for performing certain maneuvers during surgery and who find that suchskill cannot be implemented using the robotic system. Finally, roboticsurgical systems may be vulnerable to malfunction or operator error,despite safety interlocks and power backups.

Spinal surgeries often require precision drilling and placement ofscrews or other implements in relation to the spine, and there may beconstrained access to the vertebrae during surgery that makes suchmaneuvers difficult. Catastrophic damage or death may result fromimproper drilling or maneuvering of the body during spinal surgery, dueto the proximity of the spinal cord and arteries. Common spinal surgicalprocedures include a discectomy for removal of all or part of a disk, aforaminotomy for widening of the opening where nerve roots leave thespinal column, a laminectomy for removal of the lamina or bone spurs inthe back, and spinal fusion for fusing of two vertebrae or vertebralsegments together to eliminate pain caused by movement of the vertebrae.

Spinal surgeries that involve screw placement require preparation ofholes in bone (e.g., vertebral segments) prior to placement of thescrews. Where such procedures are performed manually, in someimplementations, a surgeon judges a drill trajectory for subsequentscrew placement on the basis of pre-operative CT scans. Other manualmethods which do not involve usage of the pre-operative CT scans, suchas fluoroscopy, 3D fluoroscopy or natural landmark-based, may be used todetermine the trajectory for preparing holes in bone prior to placementof the screws. In some implementations, the surgeon holds the drill inhis hand while drilling, and fluoroscopic images are obtained to verifyif the trajectory is correct. Some surgical techniques involve usage ofdifferent tools, such as a pedicle finder or K-wires. Such proceduresrely strongly on the expertise of the surgeon, and there is significantvariation in success rate among different surgeons. Screw misplacementis a common problem in such surgical procedures.

Image-guided spinal surgeries involve optical tracking to aid in screwplacement. However, such procedures are currently performed manually,and surgical tools can be inaccurately positioned despite virtualtracking. A surgeon is required to coordinate his real-world, manualmanipulation of surgical tools using images displayed on a twodimensional screen. Such procedures can be non-intuitive and requiretraining, since the surgeon's eye must constantly scan both the surgicalsite and the screen to confirm alignment. Furthermore, procedural errorcan result in registration inaccuracy of the image-guiding system,rendering it useless, or even misleading.

Certain force feedback systems are used by surgeons in certainprocedures; however such systems have a large footprint and take upvaluable, limited space in the operating room. These systems alsorequire the use of surgical tools that are specially adapted for usewith the force feedback system, and the training required by surgeons tooperate such systems can be significant. Moreover, surgeons may not beable to use expertise they have developed in performing spinal surgerieswhen adapting to use of the current force feedback systems. Suchsystems, while precise, may require more surgical time and moreoperating room preparation time to ready placement of the equipment forsurgery. Thus, there is a need for systems, apparatus, and methods thatprovide enhanced precision in performing surgeries such as spinalsurgeries.

SUMMARY

Described herein is a surgical instrument guide for use with a roboticsurgical system, for example, during spinal surgery. In certainembodiments, the guide is attached to or is part of an end effector of arobotic arm, and provides a rigid structure that allows for precisepreparation of patient tissue (e.g., preparation of a pedicle) bydrilling, tapping, or other manipulation, as well as precise placementof a screw in a drilled hole or affixation of a prosthetic or implant ina prepared patient situation.

In certain embodiments, the guide has a tubular shape with alongitudinal notch along a portion of its length. The notch is sized toallow a surgical instrument to slide through the guide in a fixedorientation while the guide is held by the robotic arm at a desired,fixed trajectory in relation to the patient. In some implementations,the guide has more than one notch (e.g., two notches). Among otherthings, incorporation of two or more notches permits ambidextrousmanipulation of the end effector and/or tool.

The surgical instrument, in some implementations, is fitted with a toolsupport having a navigational marker (e.g., a multipoint, planar marker)attached thereto via a peg sized to fit in the notch. In someimplementations, the peg is utilized without the navigation marker tomaintain the orientation of the surgical instrument. The tool supportconstrainably slides along at least a portion of the guide interior. Theguide restricts the movement of the tool support (and hence the surgicalinstrument) as the surgical instrument slides along the interior of theguide. Thus, because of the notch, movement of the marker is constrainedin a fixed orientation as it slides along the axis defined by the guide,e.g., the marker cannot rotate about the axis along which movement ofthe surgical tool is constrained. This facilitates and simplifiestracking of the marker, e.g., via a remote tracking system that displaysreal-time tracking of the surgical instrument during the surgicalprocedure.

The guide, in some implementations, also allows better control andmaneuverability of the surgical tool, since rotation of the tool isdisallowed (e.g., by the notch in the guide and the peg on the toolsupport) as the surgeon slides it through the guide along the fixedtrajectory. Furthermore, the guide still allows the robotic arm tocompensate for a force or torque applied by the surgeon, maintaining thefixed trajectory in relation to the patient despite the applied force ortorque.

The disclosed technology, in certain embodiments, includes a surgicalinstrument guide for use with a robotic surgical system. The surgicalinstrument guide may include a rigid hollow tubular structure having afirst open end and a second open end that define an axis along whichmovement of a surgical instrument (fitted with a tool support) slidingthrough the structure is restricted. The tubular structure (e.g., acylindrical structure) may have an interior surface shaped and sized toaccommodate the tool support sliding through the guide such thatmovement of the tool support is constrained in all directions exceptalong the axis defined by the guide. The tubular structure may have anexterior surface comprising at least one flange that is configured forsecure coupling of the guide to an end effector of the robotic surgicalsystem. In certain embodiments, the tubular structure includes alongitudinal notch (e.g., a slot) along its length that is sized inrelation to a peg to (i) permit a navigation marker attached to the toolsupport via the peg to be viewable by a navigation camera along anentire range of movement of the tool support through the guide, (ii)constrain movement of the marker in a fixed orientation along the axisdefined by the guide, and (ii) permit the tool support to slide alongthe axis defined by the guide while the guide is held in a fixedposition by the robotic surgical system. The navigation marker may beused by navigation camera to track the surgical instrument. Thenavigation marker may be, for example, navigation tracker such as theDedicated NavLock™ tracker from Medtronic, Inc. of Minneapolis, Minn.

The longitudinal notch may be sized in relation to a peg to permit thesurgical instrument to slide along the axis of insertion in reference tothe tool support. In certain embodiments, the surgical instrument is adrill bit, tap, screw driver, or an awl. For example, the surgicalinstrument may be a drill bit and the surgical instrument guide may be adrill guide. In certain embodiments, the surgical instrument guide isconfigured to be used to guide a screw implant and a tissue protector.

The disclosed technology, in certain embodiments, includes a robotic armwith an end effector comprising a surgical instrument guide configuredto hold and/or restrict movement of a surgical instrument therethrough.The system may include a manipulator configured to allowrobotically-assisted or unassisted positioning and/or movement of thesurgical instrument guide by a user with at least four degrees offreedom to align an axis defined by the instrument guide at a desiredtrajectory (e.g., a desired path of the surgical tool) in relation to apatient situation. The surgical instrument guide may include a rigidhollow tubular structure having a first open end and a second open endand the structure may define the axis along which movement of a surgicalinstrument (fitted with a tool support) sliding through the structure isrestricted.

The disclosed technology, in certain embodiments, includes a method ofperforming surgery with a robotic surgical system. The method mayinclude moving a mobile cart transporting a robotic surgical systemcomprising a robotic arm in proximity to an operating table, wherein therobotic arm has an end effector comprising a surgical instrument guideattached thereto, the surgical instrument guide configured to holdand/or restrict movement of a surgical instrument therethrough. Themethod may include stabilizing the mobile cart and maneuvering therobotic arm to a desired position to align an axis defined by theinstrument guide at a desired trajectory in relation to a patientsituation. The surgical instrument guide may include a rigid hollowtubular structure having a first open end and a second open end, saidstructure defining the axis along which movement of a surgicalinstrument (fitted with a tool support) sliding through the structure isrestricted.

Stabilizing the mobile cart may include extracting one or more rigidlegs on the mobile cart such that the mobile cart rests on the one ormore rigid legs of the mobile cart. In certain embodiments, stabilizingthe mobile cart includes retracting one or more wheels on the mobilecart such that the mobile cart rests on one or more rigid legs of themobile cart.

In certain embodiments, the method includes fixing the position of therobotic arm (and, therefore, the position of the surgical instrumentguide) and maneuvering the surgical instrument in a manner that isconstrained by the surgical instrument guide. In certain embodiments,prior to maneuvering the robotic arm to a desired position, obtaining oraccessing a CT scan, 3D CT scan, fluoroscopy, 3D fluoroscopy, or naturallandmark-based image of the patient situation. The method may includemaneuvering the surgical instrument through the surgical instrumentguide and maneuvering the drill bit through the drill bit guide.

The disclosed technology, in certain embodiments, includes a surgicalinstrument guide for use with a robotic surgical system. The surgicalinstrument guide may include a rigid hollow tubular structure having afirst open end and a second open end, said structure defining an axisalong which movement of a surgical instrument (fitted with a toolsupport) sliding through the structure is restricted. The tubularstructure may have an interior surface shaped and sized to accommodatethe tool support sliding through the guide such that movement of thetool support is constrained in all directions except along the axisdefined by the guide. The tubular structure may have an exterior surfacecomprising at least one flange that is configured for secure coupling ofthe guide to an end effector of the robotic surgical system. The tubularstructure, in some implementations, includes a longitudinal notch alongits length, wherein the longitudinal notch is sized in relation to a pegto (i) permit a navigation marker attached to the tool support via thepeg to be viewable by a navigation camera along an entire range ofmovement of the tool support through the guide, (ii) constrain movementof the marker in a fixed orientation along the axis defined by theguide, and (ii) permit the tool support to slide along the axis definedby the guide while the guide is held in a fixed position by the roboticsurgical system.

In certain embodiments, the surgical instrument guide includes a lockthat, when engaged, restricts (e.g., prevents) movement of the surgicalinstrument within the rigid hollow tubular structure. The lock, in someimplementations, when engaged, prevents movement of the surgicalinstrument within the rigid hollow tubular structure beyond a presetposition along the axis defined by the guide. The lock, when engaged,may prevent removal of the surgical instrument from the surgicalinstrument guide. The lock may be an end lock that, when engaged,prevents removal of the surgical instrument from the surgical instrumentguide. The lock may be an intermediate lock that, when engaged, preventsmovement of the surgical instrument within the rigid hollow tubularstructure beyond a preset position along the axis defined by the guide.

In certain embodiments, the surgical instrument guide includes aninstrument position sensor (e.g., inductive sensor, capacitive sensor,resistive sensor, mechanical end switches, optical measuring device,force sensing device, or other similar position sensor) configured todetect the position of the surgical instrument in the rigid hollowtubular structure.

The disclosed technology, in certain embodiments, includes a roboticsurgical system for performing surgery. The system may include a roboticarm with an end effector comprising a surgical instrument guideconfigured to hold and/or restrict movement of a surgical instrumenttherethrough, and a manipulator configured to allow robotically-assistedor unassisted positioning and/or movement of the surgical instrumentguide by a user with at least four degrees of freedom to align an axisdefined by the instrument guide at a desired trajectory in relation to apatient situation. The surgical instrument guide may include a rigidhollow tubular structure having a first open end and a second open end,said structure defining the axis along which movement of a surgicalinstrument (fitted with a tool support) sliding through the structure isrestricted. The tubular structure has an interior surface shaped andsized to accommodate the tool support sliding through the guide suchthat movement of the tool support is constrained in all directionsexcept along the axis defined by the guide. The tubular structure mayhave an exterior surface comprising at least one flange that isconfigured for secure coupling of the guide to the end-effector of therobotic surgical system. The tubular structure may include alongitudinal notch along its length, wherein the longitudinal notch issized in relation to a peg to (i) permit a navigation marker attached tothe tool support via the peg to be viewable by a navigation camera alongan entire range of movement of the tool support through the guide, (ii)constrain movement of the marker in a fixed orientation along the axisdefined by the guide, and (ii) permit the tool support to slide alongthe axis defined by the guide while the guide is held in a fixedposition by the robotic surgical system. The surgical instrument guidemay include a lock that, when engaged, restricts (e.g., prevents)movement of the surgical instrument within the rigid hollow tubularstructure.

The disclosed technology, in certain embodiments, includes a method ofperforming surgery with a robotic surgical system. The method mayinclude obtaining access to one or more vertebrae of a patient;attaching a patient navigation marker to the patient; registering thepatient (e.g., using intra-operative images of the patient situation;e.g., 3D fluoroscopy images); moving a mobile cart transporting arobotic surgical system that includes a robotic arm in proximity to anoperating table, wherein the robotic arm has an end effector thatincludes a surgical instrument guide attached thereto, the surgicalinstrument guide configured to hold and/or restrict movement of asurgical instrument therethrough; stabilizing the mobile cart; insertinga first surgical instrument into the surgical instrument guide until anintermediate lock of the surgical instrument guide is engaged;maneuvering the robotic arm to a desired position to align an axisdefined by the instrument guide at a desired trajectory in relation to apatient situation, wherein the surgical instrument guide includes arigid hollow tubular structure having a first open end and a second openend, said structure defining the axis along which movement of a surgicalinstrument (fitted with a tool support) sliding through the structure isrestricted; fixing the position of the robotic arm (and, therefore, theposition of the surgical instrument guide); maneuvering the surgicalinstrument along the desired trajectory, wherein the robotic surgicalsystem assists in said maneuvering; releasing, the intermediate lock andplacing the robotic arm in a hold position mode; manually preparing ahole for a screw using the first surgical instrument; removing the firstsurgical instrument from the surgical instrument guide; and inserting animplant through the guiding tube and fixing the implant to one of theone or more vertebrae.

The disclosed technology, in certain embodiments, includes a method ofperforming surgery with a robotic surgical system. The method mayinclude attaching a patient navigation marker to the patient;registering the patient (e.g., using intra-operative images of thepatient situation. e.g., 3D fluoroscopy images); moving a mobile carttransporting a robotic surgical system that includes a robotic arm inproximity to an operating table, wherein the robotic arm has an endeffector that includes a surgical instrument guide attached thereto, thesurgical instrument guide configured to hold and/or restrict movement ofa surgical instrument therethrough; stabilizing the mobile cart;inserting a first surgical instrument into the surgical instrument guideuntil an intermediate lock of the surgical instrument guide is engaged;maneuvering the robotic arm to a desired position to align an axisdefined by the instrument guide at a desired trajectory in relation to apatient situation, wherein the surgical instrument guide includes arigid hollow tubular structure having a first open end and a second openend, said structure defining the axis along which movement of a surgicalinstrument (fitted with a tool support) sliding through the structure isrestricted, wherein the desired trajectory is stored in a memory deviceof the robotic surgical system; maneuvering the robotic arm such that asurgeon may manually access one or more vertebrae; obtaining access toone or more vertebrae of a patient; maneuvering the robotic arm such tothe desired position to align the axis defined by the instrument guideat the desired trajectory, wherein the robotic surgical system assistsin said maneuvering; maneuvering the surgical instrument along thedesired trajectory, wherein the robotic surgical system assists in saidmaneuvering; releasing, the intermediate lock and placing the roboticarm in a hold position mode; manually preparing a hole for a screw usingthe first surgical instrument; removing the first surgical instrumentfrom the surgical instrument guide; and inserting an implant through theguiding tube and fixing the implant to one of the one or more vertebrae.

The disclosed technology, in certain embodiments, A surgical instrumentguide for use with a robotic surgical system, the surgical instrumentguide comprising a rigid hollow tubular structure having a first openend and a second open end, said structure defining an axis along whichmovement of a surgical instrument (fitted with a tool support) slidingthrough the structure is restricted, wherein the tubular structure hasan interior surface shaped and sized to accommodate the tool supportsliding through the guide such that movement of the tool support isconstrained in all directions except along the axis defined by theguide, wherein the tubular structure has an exterior surface comprisingat least one flange that is configured for secure coupling of the guideto an end effector of the robotic surgical system, and wherein thetubular structure comprises a longitudinal notch along its length,wherein the longitudinal notch is sized in relation to a peg to (i)permit a navigation marker attached to the tool support via the peg tobe viewable by a navigation camera along an entire range of movement ofthe tool support through the guide, (ii) constrain movement of themarker in a fixed orientation along the axis defined by the guide, and(ii) permit the tool support to slide along the axis defined by theguide while the guide is held in a fixed position by the roboticsurgical system.

The disclosed technology, in certain embodiments, includes a roboticsurgical system for performing surgery. In some implementations, thesystem includes: a robotic arm with an end effector comprising asurgical instrument guide configured to hold and/or restrict movement ofa surgical instrument therethrough; and a manipulator configured toallow robotically-assisted or unassisted positioning and/or movement ofthe surgical instrument guide by a user with at least four degrees offreedom to align an axis defined by the instrument guide at a desiredtrajectory in relation to a patient situation, wherein the surgicalinstrument guide comprises a rigid hollow tubular structure having afirst open end and a second open end, said structure defining the axisalong which movement of a surgical instrument (fitted with a toolsupport) sliding through the structure is restricted, wherein thetubular structure has an interior surface shaped and sized toaccommodate the tool support sliding through the guide such thatmovement of the tool support is constrained in all directions exceptalong the axis defined by the guide, wherein the tubular structure hasan exterior surface comprising at least one flange that is configuredfor secure coupling of the guide to the end-effector of the roboticsurgical system, and wherein the tubular structure comprises alongitudinal notch along its length, wherein the longitudinal notch issized in relation to a peg to (i) permit a navigation marker attached tothe tool support via the peg to be viewable by a navigation camera alongan entire range of movement of the tool support through the guide, (ii)constrain movement of the marker in a fixed orientation along the axisdefined by the guide, and (ii) permit the tool support to slide alongthe axis defined by the guide while the guide is held in a fixedposition by the robotic surgical system.

In certain embodiments, the surgical instrument is a drill bit, tap,screw driver, or awl. In certain embodiments, the surgical instrument isa drill bit and the surgical instrument guide is a drill guide. Incertain embodiments, the robotic surgical system is for use in spinalsurgery.

In certain embodiments, the rigid hollow tubular structure is acylindrical structure. In certain embodiments, the longitudinal notch isa slot. In certain embodiments, the longitudinal notch is sized inrelation to a peg to permit the surgical instrument to slide along theaxis of insertion in reference to the tool support. In certainembodiments, the navigation marker is used by navigation camera to trackthe surgical instrument. In certain embodiments, the surgical instrumentguide is configured to be used to guide a screw implant and a tissueprotector.

In certain embodiments, the manipulator is attached to the robotic arm.In certain embodiments, the manipulator is molded into the robotic arm.In certain embodiments, the axis can be aligned with the desiredtrajectory in relation to the patient situation via the manipulator.

The disclosed technology, in certain embodiments, includes a method ofperforming surgery with a robotic surgical system. In certainembodiments, the method includes: moving a mobile cart transporting arobotic surgical system comprising a robotic arm in proximity to anoperating table, wherein the robotic arm has an end effector comprisinga surgical instrument guide attached thereto, the surgical instrumentguide configured to hold and/or restrict movement of a surgicalinstrument therethrough; stabilizing the mobile cart; maneuvering therobotic arm to a desired position to align an axis defined by theinstrument guide at a desired trajectory in relation to a patientsituation, wherein the surgical instrument guide comprises a rigidhollow tubular structure having a first open end and a second open end,said structure defining the axis along which movement of a surgicalinstrument (fitted with a tool support) sliding through the structure isrestricted; fixing the position of the robotic arm (and, therefore, theposition of the surgical instrument guide); and maneuvering the surgicalinstrument in a manner that is constrained by the surgical instrumentguide, wherein: the surgical instrument is fitted with a tool supportshaped and sized to slide through the surgical instrument guide alongthe axis defined by the guide, the tubular structure of the surgicalinstrument guide has an interior surface shaped and sized to accommodatethe tool support sliding through the guide such that movement of thetool support is constrained in all directions except along the axisdefined by the guide, and the tubular structure comprises a longitudinalnotch along its length, wherein the longitudinal notch is sized inrelation to a peg to (i) permit a marker attached to the tool supportvia the peg to be viewable by a navigation camera along an entire rangeof movement of the tool support through the guide, (ii) constrainmovement of the navigation marker in a fixed orientation along the axisdefined by the guide, and (ii) permit the tool support to slide alongthe axis defined by the guide while the guide is held in a fixedposition by the robotic surgical system.

In certain embodiments, stabilizing the mobile cart includes extractingone or more rigid legs on the mobile cart such that the mobile cartrests on the one or more rigid legs of the mobile cart. In certainembodiments, stabilizing the mobile cart includes retracting one or morewheels on the mobile cart such that the mobile cart rests on one or morerigid legs of the mobile cart.

In certain embodiments, prior to maneuvering the robotic arm to adesired position, the method includes obtaining or accessing a CT scan,3D CT scan, fluoroscopy, 3D fluoroscopy, or natural landmark-based imageof the patient situation. In certain embodiments, the method includesmaneuvering the surgical instrument through the surgical instrumentguide. In certain embodiments, the method includes maneuvering the drillbit through the drill bit guide.

In certain embodiments, the desired trajectory is a desired path of thesurgical tool. In certain embodiments, the tubular structure includes asecond longitudinal notch along its length, wherein the secondlongitudinal notch is sized in relation to a peg to (i) permit anavigation marker attached to the tool support via the peg to beviewable by a navigation camera along an entire range of movement of thetool support through the guide, (ii) constrain movement of the marker ina fixed orientation along the axis defined by the guide, and (ii) permitthe tool support to slide along the axis defined by the guide while theguide is held in a fixed position by the robotic surgical system.

The disclosed technology, in certain embodiments, includes a surgicalinstrument guide for use with a robotic surgical system. In certainembodiments, the surgical instrument guide includes a rigid hollowtubular structure having a first open end and a second open end, saidstructure defining an axis along which movement of a surgical instrument(fitted with a tool support) sliding through the structure isrestricted, wherein the tubular structure has an interior surface shapedand sized to accommodate the tool support sliding through the guide suchthat movement of the tool support is constrained in all directionsexcept along the axis defined by the guide, wherein the tubularstructure has an exterior surface comprising at least one flange that isconfigured for secure coupling of the guide to an end effector of therobotic surgical system, and wherein the tubular structure comprises alongitudinal notch along its length, wherein the longitudinal notch issized in relation to a peg to (i) permit a navigation marker attached tothe tool support via the peg to be viewable by a navigation camera alongan entire range of movement of the tool support through the guide, (ii)constrain movement of the marker in a fixed orientation along the axisdefined by the guide, and (ii) permit the tool support to slide alongthe axis defined by the guide while the guide is held in a fixedposition by the robotic surgical system; and a lock that, when engaged,restricts (e.g., prevents) movement of the surgical instrument withinthe rigid hollow tubular structure.

In certain embodiments, the lock, when engaged, prevents movement of thesurgical instrument within the rigid hollow tubular structure beyond apreset position along the axis defined by the guide. In certainembodiments, the lock, when engaged, prevents removal of the surgicalinstrument from the surgical instrument guide. In certain embodiments,the lock is an end lock that, when engaged, prevents removal of thesurgical instrument from the surgical instrument guide. In certainembodiments, the lock is an intermediate lock that, when engaged,prevents movement of the surgical instrument within the rigid hollowtubular structure beyond a preset position along the axis defined by theguide.

In certain embodiments, the disclosed technology includes an instrumentposition sensor (e.g., inductive sensor, capacitive sensor, resistivesensor, mechanical end switches, optical measuring device, force sensingdevice, or other similar position sensor) configured to detect theposition of the surgical instrument in the rigid hollow tubularstructure.

In certain embodiments, the robotic surgical system includes: a roboticarm with an end effector comprising a surgical instrument guideconfigured to hold and/or restrict movement of a surgical instrumenttherethrough; and a manipulator configured to allow robotically-assistedor unassisted positioning and/or movement of the surgical instrumentguide by a user with at least four degrees of freedom to align an axisdefined by the instrument guide at a desired trajectory in relation to apatient situation, wherein the surgical instrument guide comprises arigid hollow tubular structure having a first open end and a second openend, said structure defining the axis along which movement of a surgicalinstrument (fitted with a tool support) sliding through the structure isrestricted, wherein the tubular structure has an interior surface shapedand sized to accommodate the tool support sliding through the guide suchthat movement of the tool support is constrained in all directionsexcept along the axis defined by the guide, wherein the tubularstructure has an exterior surface comprising at least one flange that isconfigured for secure coupling of the guide to the end-effector of therobotic surgical system, wherein the tubular structure comprises alongitudinal notch along its length, wherein the longitudinal notch issized in relation to a peg to (i) permit a navigation marker attached tothe tool support via the peg to be viewable by a navigation camera alongan entire range of movement of the tool support through the guide, (ii)constrain movement of the marker in a fixed orientation along the axisdefined by the guide, and (ii) permit the tool support to slide alongthe axis defined by the guide while the guide is held in a fixedposition by the robotic surgical system, and wherein the surgicalinstrument guide comprises a lock that, when engaged, restricts (e.g.,prevents) movement of the surgical instrument within the rigid hollowtubular structure.

The disclosed technology, in certain embodiments, includes a method ofperforming surgery with a robotic surgical system, the method including:obtaining access to one or more vertebrae of a patient; attaching apatient navigation marker to the patient; registering the patient (e.g.,using intra-operative images of the patient situation; e.g., 3Dfluoroscopy images); moving a mobile cart transporting a roboticsurgical system comprising a robotic arm in proximity to an operatingtable, wherein the robotic arm has an end effector comprising a surgicalinstrument guide attached thereto, the surgical instrument guideconfigured to hold and/or restrict movement of a surgical instrumenttherethrough; stabilizing the mobile cart; inserting a first surgicalinstrument into the surgical instrument guide until an intermediate lockof the surgical instrument guide is engaged; maneuvering the robotic armto a desired position to align an axis defined by the instrument guideat a desired trajectory in relation to a patient situation, wherein thesurgical instrument guide comprises a rigid hollow tubular structurehaving a first open end and a second open end, said structure definingthe axis along which movement of a surgical instrument (fitted with atool support) sliding through the structure is restricted; fixing theposition of the robotic arm (and, therefore, the position of thesurgical instrument guide); maneuvering the surgical instrument alongthe desired trajectory, wherein the robotic surgical system assists insaid maneuvering; releasing, the intermediate lock and placing therobotic arm in a hold position mode; manually preparing a hole for ascrew using the first surgical instrument; removing the first surgicalinstrument from the surgical instrument guide; and inserting an implantthrough the guiding tube and fixing the implant to one of the one ormore vertebrae.

The disclosed technology, in certain embodiments, includes a method ofperforming surgery with a robotic surgical system, the method includes:attaching a patient navigation marker to the patient; registering thepatient (e.g., using intra-operative images of the patient situation.e.g., 3D fluoroscopy images); moving a mobile cart transporting arobotic surgical system comprising a robotic arm in proximity to anoperating table, wherein the robotic arm has an end effector comprisinga surgical instrument guide attached thereto, the surgical instrumentguide configured to hold and/or restrict movement of a surgicalinstrument therethrough; stabilizing the mobile cart; inserting a firstsurgical instrument into the surgical instrument guide until anintermediate lock of the surgical instrument guide is engaged;maneuvering the robotic arm to a desired position to align an axisdefined by the instrument guide at a desired trajectory in relation to apatient situation, wherein the surgical instrument guide comprises arigid hollow tubular structure having a first open end and a second openend, said structure defining the axis along which movement of a surgicalinstrument (fitted with a tool support) sliding through the structure isrestricted, wherein the desired trajectory is stored in a memory deviceof the robotic surgical system; maneuvering the robotic arm such that asurgeon may manually access one or more vertebrae; obtaining access toone or more vertebrae of a patient; maneuvering the robotic arm such tothe desired position to align the axis defined by the instrument guideat the desired trajectory, wherein the robotic surgical system assistsin said maneuvering; maneuvering the surgical instrument along thedesired trajectory, wherein the robotic surgical system assists in saidmaneuvering; releasing, the intermediate lock and placing the roboticarm in a hold position mode; manually preparing a hole for a screw usingthe first surgical instrument; removing the first surgical instrumentfrom the surgical instrument guide; and inserting an implant through theguiding tube and fixing the implant to one of the one or more vertebrae.

In certain embodiments, the surgical instrument is fitted with a toolsupport shaped and sized to slide through the surgical instrument guidealong the axis defined by the guide, the tubular structure of thesurgical instrument guide has an interior surface shaped and sized toaccommodate the tool support sliding through the guide such thatmovement of the tool support is constrained in all directions exceptalong the axis defined by the guide, and the tubular structure comprisesa longitudinal notch along its length, wherein the longitudinal notch issized in relation to a peg to (i) permit a marker attached to the toolsupport via the peg to be viewable by a navigation camera along anentire range of movement of the tool support through the guide, (ii)constrain movement of the navigation marker in a fixed orientation alongthe axis defined by the guide, and (ii) permit the tool support to slidealong the axis defined by the guide while the guide is held in a fixedposition by the robotic surgical system.

In certain embodiments, the system includes an instrument positionsensor configured to detect the position of the surgical instrument inthe rigid hollow tubular structure.

In certain embodiments, the surgical instrument guide includes a lockthat, when engaged, restricts (e.g., prevents) movement of the surgicalinstrument within the rigid hollow tubular structure. In certainembodiments, the surgical instrument guide includes one or more inputdevices (e.g., one or more electro-mechanical buttons; e.g., two inputdevices). In certain embodiments, the surgical instrument guide includesan activation switch (e.g., sized and shaped to detect the presence of asurgeon's hand on the surgical instrument guide).

BRIEF DESCRIPTION OF THE FIGURES

The foregoing and other objects, aspects, features, and advantages ofthe present disclosure will become more apparent and better understoodby referring to the following description taken in conjunction with theaccompanying drawings, in which:

FIG. 1 is an illustration of an example robotic surgical system in anoperating room;

FIG. 2 is an illustration of an example configuration of a robotic armfor performing a surgical operation;

FIG. 3 is an illustration of an example surgical instrument guide foruse with a robotic surgical system;

FIGS. 4A-B are illustrations of an example surgical instrument for usewith a robotic surgical system;

FIGS. 5A-B are illustrations of an example surgical instrument for usewith a robotic surgical system;

FIG. 6 is an illustration of a surgical instrument being used with asurgical instrument guide;

FIGS. 7A-B are illustrations of an example surgical instrument in whicha surgical instrument tool is sliding through a surgical instrumentguide;

FIG. 8 is a flowchart of an example method of performing surgery with arobotic surgical system;

FIG. 9 is a flowchart of an example of a method for performing aminimally invasive surgery using a robotic surgical system as a drillguide;

FIG. 10A is an illustration of an example surgical instrument guide foruse with a robotic surgical system;

FIG. 10B is an illustration of an example surgical instrument guide withan intermediate lock for use with a robotic surgical system;

FIG. 10C is an illustration of an example surgical instrument guide withan end lock for use with a robotic surgical system;

FIG. 11 is an illustration of an example surgical instrument guide foruse with a robotic surgical system;

FIG. 12 is a flowchart of an example method for performing surgery witha robotic surgical system;

FIG. 13 is a flowchart of an example of a method for performing aminimally invasive surgery using a robotic surgical system as a drillguide;

FIG. 14 shows a block diagram of an exemplary cloud computingenvironment; and

FIG. 15 is a block diagram of a computing device and a mobile computingdevice.

The features and advantages of the present disclosure will become moreapparent from the detailed description set forth below when taken inconjunction with the drawings, in which like reference charactersidentify corresponding elements throughout. In the drawings, likereference numbers generally indicate identical, functionally similar,and/or structurally similar elements.

DETAILED DESCRIPTION

FIG. 1 illustrates an example robotic surgical system in an operatingroom 100. In some implementations, one or more surgeons, surgicalassistants, surgical technologists and/or other technicians (e.g., 106a-c) perform an operation on a patient 104 using a robotic-assistedsurgical system. In the operating room 100 the surgeon may be guided bythe robotic system to accurately execute an operation. This may beachieved by robotic guidance of the surgical tools, including ensuringthe proper trajectory of the tool (e.g., drill or screw). In someimplementations, the surgeon defines the trajectory intra-operativelywith little or no pre-operative planning. The system allows a surgeon tophysically manipulate the tool holder to safely achieve proper alignmentof the tool for performing crucial steps of the surgical procedure.Operation of the robot arm by the surgeon (or other operator) in forcecontrol mode permits movement of the tool in a measured, even mannerthat disregards accidental, minor movements of the surgeon. The surgeonmoves the tool holder to achieve proper trajectory of the tool (e.g., adrill or screw) prior to operation or insertion of the tool into thepatient 104. Once the robotic arm is in the desired position, the arm isfixed to maintain the desired trajectory. The tool holder serves as astable, secure guide through which a tool may be moved through or slidat an accurate angle. Thus, the disclosed technology provides thesurgeon with reliable instruments and techniques to successfully performhis/her surgery.

In some embodiments, the operation may be spinal surgery, such as adiscectomy, a foraminotomy, a laminectomy, or a spinal fusion. In someimplementations, the surgical robotic system includes a surgical robot102 on a mobile cart 114. The surgical robot 102 in the example shown inFIG. 1 is positioned in proximity to an operating table 112 withoutbeing attached to the operating table 112, thereby providing maximumoperating area and mobility to surgeons around the operating table 112and reducing clutter on the operating table 112. In alternativeembodiments, the surgical robot 102 (or cart) is securable to theoperating table 112. In certain embodiments, both the operating table112 and the cart 114 are secured to a common base to prevent anymovement of the cart or table 112 in relation to each other, even in theevent of an earth tremor.

The mobile cart 114 may permit a user (operator) 106 a, such as atechnician, nurse, surgeon, or any other medical personnel in theoperating room 100, to move the surgical robot 102 to differentlocations before, during, and/or after a surgical procedure. The mobilecart 104 enables the surgical robot 102 to be easily transported intoand out of the operating room 100. For example, a user 106 a may movethe surgical robot 102 into the operating room 100 from a storagelocation. In some implementations, the mobile cart 114 may includewheels, a track system, such as a continuous track propulsion system, orother similar mobility systems for translocation of the cart. The mobilecart 114 may include an attached or embedded handle for locomotion ofthe mobile cart 114 by an operator (e.g., user 106 a).

For safety reasons, the mobile cart 114 may be provided with astabilization system that may be used during a surgical procedureperformed with a surgical robot 102. The stabilization mechanismincreases the global stiffness of the mobile cart 114 relative to thefloor in order to ensure the accuracy of the surgical procedure. In someimplementations, the wheels include a locking mechanism that preventsthe cart 114 from moving. The stabilizing, braking, and/or lockingmechanism may be activated when the machine is turned on. In someimplementations, the mobile cart 114 includes multiple stabilizing,braking, and/or locking mechanisms. In some implementations, thestabilizing mechanism is electro-mechanical with electronic activation.The stabilizing, braking, and/or locking mechanism(s) may be entirelymechanical. The stabilizing, braking, and/or locking mechanism(s) may beelectronically activated and deactivated.

In some implementations, the surgical robot 102 includes a robotic armmounted on a mobile cart 114. An actuator may move the robotic arm. Therobotic arm may include a force control end-effector configured to holda surgical tool. The robot 102 may be configured to control and/or allowpositioning and/or movement of the end-effector with at least fourdegrees of freedom (e.g., six degrees of freedom, three translations andthree rotations).

In some implementations, the robotic arm is configured to releasablyhold a surgical tool, allowing the surgical tool to be removed andreplaced with a second surgical tool. The system may allow the surgicaltools to be swapped without re-registration, or with automatic orsemi-automatic re-registration of the position of the end-effector.

In some implementations, the surgical system includes a surgical robot102, a tracking detector 108 that captures the position of the patientand different components of the surgical robot 102, and a display screen110 that displays, for example, real time patient data and/or real timesurgical robot trajectories.

In some implementations, a tracking detector 108 monitors the locationof patient 104 and the surgical robot 102. The tracking detector 108 maybe a camera, a video camera, an infrared detector, field generator andsensors for electro-magnetic tracking or any other motion detectingapparatus. In some implementation, based on the patient and robotposition, the display screen 110 displays a projected trajectory and/ora proposed trajectory for the robotic arm of robot 102 from its currentlocation to a patient operation site. By continuously monitoring thepatient 104 and robotic arm positions, using tracking detector 108, thesurgical system can calculate updated trajectories and visually displaythese trajectories on display screen 110 to inform and guide surgeonsand/or technicians in the operating room 100 using the surgical robot.In addition, in certain embodiments, the surgical robot 102 may alsochange its position and automatically position itself based ontrajectories calculated from the real time patient and robotic armpositions captured using the tracking detector 108. For instance, thetrajectory of the end-effector can be automatically adjusted in realtime to account for movement of the vertebrae and/or other part of thepatient 104 during the surgical procedure.

FIG. 2 illustrates an example configuration 200 of a robotic arm 202 forperforming a surgical operation. The robotic surgical system includes arobotic arm 202 and a end-effector 204. The manipulator (not shown inFIG. 2), such as a handle on the robotic arm and/or near the endeffector, can be used by a surgeon for robotically-assisted orunassisted positioning and/or movement of the surgical instrument guide206 by a user with at least four degrees of freedom (e.g., six degreesof freedom, three translations and three rotations) to align an axisdefined by the instrument guide 206 at a desired trajectory in relationto a patient situation 210. The axis can be aligned with the desiredtrajectory in relation to the patient situation 210 via the manipulator.

An end-effector, such as surgical instrument guide 206, is coupled tothe robotic arm 202 for precisely guiding instruments during surgery.For example, the surgical instrument guide 206 may be coupled to therobotic arm via a flange. The surgical instrument guide 206 isconfigured to hold and/or restrict movement of a surgical instrument(e.g., drill guide 212) therethrough. As shown in FIG. 2, in someimplementations, the surgical instrument is a drill guide 212 throughwhich the drill bit 208 of a drill 218 is passed. Such a system may beused to perform spinal surgery. In some implementations, the surgicaltool may be, for example, a tap such as the StealthStation® CR HorizonLegacy Taps from Medtronic, Inc. of Minneapolis, Minn. Other surgicalinstruments may be used by the system, such as a screw driver or awl.For example, the surgical instrument guide may be configured to be usedto guide a screw implant and/or a tissue protector.

FIG. 3 illustrates an example surgical instrument guide 300 for use witha robotic surgical system. In some implementations, the same guide 300is used to guide all the instruments utilized with a robotic surgicalsystem. For example, the robot may not move during the complete pediclepreparation and implant placement of one screw. In minimally invasivesurgeries, screw extensions may also pass through the guide whichprevents the need to move the robot between pedicle preparation andscrew placement. This guarantees best possible alignment of screw withrespect to previously prepared hole.

In some implementations, the surgical instrument guide comprising arigid hollow tubular structure 306 having a first open end 308 and asecond open end 310. In some implementations, the tubular structure 306is a cylindrical structure. The tubular structure 306 has one or moreflanges 324 a-b that are configured for secure coupling of the guide 300to an end effector of the robotic surgical system. The tubular structure306, in some implementations, defines an axis along which movement of asurgical instrument (fitted with a tool support) sliding through thestructure 306 is restricted. The tubular structure 306 is configured(e.g., an interior surface of the structure 306 is shaped and sized) topermit a tool support to slide through the tubular structure 306 suchthat movement of the tool support is constrained in all directionsexcept along the axis defined by the tubular structure 306.

FIGS. 4A-B illustrate an example surgical instrument system 400 for usewith the robotic surgical system. As shown in FIG. 4A, the tool support410 is coupled to an instrument, such as drill bit 408 in this example,that is used with the robotic surgical system. In some implementations,the tool support 410 includes interface bands 414 a-b that engage theinterior surface of the tubular structure 306 of the guide 300 as shownin FIG. 3. Interface 414 a-b slide along the interior surface of theguide and permit the tool support 410 to slide through the guide suchthat movement of the tool support 410 is constrained in all directionsexcept along the axis defined by the guide. These bands 414 a-b aredesigned in order to slide into the guide allowing the surgeon toachieve a linear motion of the instrument along the guide's axis. Thenavigation marker 412 is coupled to the tool support 410 via a peg 420.In some implementations, the peg is utilized without the navigationmarker to maintain the orientation of the surgical instrument. Thenavigation marker may be, for example, navigation tracker such as theDedicated NavLock™ tracker from Medtronic, Inc. of Minneapolis, Minn. Inthe example illustrated in FIG. 4, the instrument 408 is a drill 418with a drill bit 422 that passes through a drill guide 408. FIG. 4Billustrates an example surgical operation 450 involving the surgicalinstrument shown in FIG. 4A and the robotic surgical system disclosedherein.

As shown in FIG. 3, the tubular structure 306, in some implementations,includes a longitudinal notch 322 along its length. In someimplementations, the longitudinal notch 322 is a slot. The longitudinalnotch 322 is sized in relation to a peg (e.g., peg 420 as shown in FIG.4) that couples a navigation marker (e.g., 412 as shown in FIG. 4) to atool support (e.g., 410 as shown in FIG. 4). In some implementations,the peg is utilized without the navigation marker to maintain theorientation of the surgical instrument. As the tool support slidesthrough the guide 300, the notch 322 permits the tool support to slidealong the axis defined by the guide while the guide is held in a fixedposition by the robotic surgical system. The peg extends through thenotch 322 and outside of the guide 300 and permits the navigation markerattached to the tool support via the peg to be viewed by a navigationcamera along an entire range of movement of the tool support through theguide 300. In some implementations, the navigation marker is used bynavigation camera to track the surgical instrument. The notch 322 mayconstrain movement of the marker in a fixed orientation along the axisdefined by the guide. In some implementations, longitudinal notch 322 issized in relation to a peg to prevent the surgical instrument fromrotating around the axis of insertion in reference to the tool support.

FIGS. 5A-B illustrate an example instrument system 500 for use with therobotic surgical system. The instrument system 500 includes a drill bit522 that is coupled to a hand drill 516 that may be used by a surgeonduring a surgical operation. The instrument system includes a toolsupport 510 and a navigational marker 512 as described above. The toolsupport 510 is connected (permanently or removably) to a drill guide 508through which the drill bit 522 passes. Other surgical instruments maybe used with the system, such as a tap, screw driver, or awl. FIG. 5Billustrates an example surgical operation 550 involving the surgicalinstrument shown in FIG. 5A and the robotic surgical system disclosedherein.

FIG. 6 is an illustration 600 of a surgical instrument 630 being usedwith a surgical instrument guide 606. In some implementations, thesurgical instrument 630 includes a tool support 610. The tool support610 includes members 614 a-b that engage the interior surface of theguide 606. Members 614 a-b slide along the interior surface of the guide606 and permit the tool support 610 to slide through the guide such thatmovement of the tool support 610 is constrained in all directions exceptalong the axis defined by the guide. The guide 606, in someimplementations, has one or more flanges that are configured for securecoupling of the guide to an end effector of the robotic surgical system.As shown in FIG. 6, the guide 606 has two flanges 624 a-b. In thisexample, the flanges 624 a-b are bolted to the manipulator 626. In someimplementations, other mounting systems are used. As described above, anavigation marker 612 is coupled to the tool support 610 via a peg 632such that the navigation marker 612 is viewable by a navigation cameraalong an entire range of movement of the tool support 610 through theguide 606.

FIGS. 7A-B illustrate an example surgical instrument system 700 in whicha surgical instrument 730 slides through a surgical instrument guide706. As discussed above, the guide 706 includes a notch 722 along itslength. As the tool support 710 (described above) slides through theguide 706, the notch 722 permits the tool support to slide along theaxis defined by the guide while the guide is held in a fixed position bythe robotic surgical system. As the tool support 710 slides through theguide 706 from the position shown in FIG. 7A to the position shown inFIG. 7B, the navigation marker 712 is viewable by a navigation cameraalong an entire range of movement of the tool support 710 through theguide 706.

FIG. 8 is a flowchart of an example method 800 of performing surgerywith a robotic surgical system, such as the robotic surgical systemdisclosed herein. In some implementations, the method 800 includesmoving a mobile cart transporting a robotic surgical system comprising arobotic arm in proximity to an operating table (802). As describedabove, the robotic arm has an end effector comprising a surgicalinstrument guide attached thereto. The surgical instrument guide is, insome implementations, configured to hold and/or restrict movement of asurgical instrument therethrough.

The method 800 may include stabilizing the mobile cart (804). For safetyreasons, the mobile cart is provided with a stabilization system thatmay be used during a surgical procedure performed with a surgical robot.The stabilization mechanism increases the global stiffness of the mobilecart relative to the floor in order to ensure the accuracy of thesurgical procedure. Once stabilization is engaged, the mobile cart issecured in place on the operating room floor and cannot move.

After stabilizing the mobile cart, the robotic arm is maneuvered to adesired position to align an axis defined by the instrument guide at adesired trajectory in relation to a patient situation (806). Asdescribed above, the surgical instrument guide may comprise a rigidhollow tubular structure having a first open end and a second open end.The structure may define the axis along which movement of a surgicalinstrument (fitted with a tool support) sliding through the structure isrestricted.

The position of the robotic arm and, therefore, the position of thesurgical instrument guide is fixed (808) after the robotic arm ismaneuvered to the desired position. After the position of the roboticarm is fixed, a surgical instrument is maneuvered in a manner that isconstrained by the surgical instrument guide (810). As described above,the surgical instrument may be fitted with a tool support shaped andsized to slide through the surgical instrument guide along the axisdefined by the guide. The tubular structure of the surgical instrumentguide may have an interior surface shaped and sized to accommodate thetool support sliding through the guide such that movement of the toolsupport is constrained in all directions except along the axis definedby the guide. The tubular structure may include a longitudinal notchalong its length that is sized in relation to a peg to (i) permit amarker attached to the tool support via the peg to be viewable by anavigation camera along an entire range of movement of the tool supportthrough the guide, (ii) constrain movement of the navigation marker in afixed orientation along the axis defined by the guide, and (ii) permitthe tool support to slide along the axis defined by the guide while theguide is held in a fixed position by the robotic surgical system.

FIG. 9 is an example of a method 900 for performing a minimally invasivesurgery using a robotic surgical system as a drill guide. The surgeon orother operator/assistant identifies a trajectory (902). The trajectorymay be identified pre-operatively, intraoperatively, or a combinationthereof. In some implementations, the trajectory is defined by acomputer algorithm. The computer may define the trajectory with orwithout the surgeon's assistance. In some implementations, thetrajectory is presented for the surgeon's approval. Next, the surgeonpositions the end effector in accordance with the trajectory (904). Thepositioning may be assisted or unassisted by the robotic surgicalsystem. In some implementations, the surgeon may be assisted usingvarious types of indications such as visual and/or sound indications.After the position of the robotic arm is fixed, a surgical instrument ismaneuvered in a manner that is constrained by the surgical instrumentguide. In this example, the surgeon drills through the tool guide (906).In the case in which a drill guide is coupled to the end effector, anoperator may insert a drill into the drill guide without moving theposition of the end effector or drill guide. Thus, after carefullypositioning the drill guide along a desired trajectory, an operator mayaccurately drill along the desired trajectory.

As described above, the surgical instrument (e.g., the drill) may befitted with a tool support shaped and sized to slide through thesurgical instrument guide along the axis defined by the guide. Thetubular structure of the surgical instrument guide may have an interiorsurface shaped and sized to accommodate the tool support sliding throughthe guide such that movement of the tool support is constrained in alldirections except along the axis defined by the guide. After drillingthrough the tool guide, the surgeon places the screw through the drilledhole (908).

FIG. 10A is an illustration of an example surgical instrument guide foruse with a robotic surgical system. In some implementations, the sameguide 1000 is used to guide all the instruments utilized with a roboticsurgical system. For example, the robot may not move during the completepedicle preparation and implant placement of one screw. In minimallyinvasive surgeries, screw extensors may also pass through the guidewhich prevents the need to move the robot between pedicle preparationand screw placement. In some implementations, this guarantees bestpossible alignment of screw with respect to previously prepared hole.

In some implementations, the surgical instrument guide comprising arigid hollow tubular structure 1006 having a first open end and a secondopen end. In some implementations, the tubular structure 1006 is acylindrical structure. The tubular structure 1006, in someimplementations, defines an axis along which movement of a surgicalinstrument (fitted with a tool support) sliding through the structure isrestricted. The tubular structure 1006 is configured (e.g., an interiorsurface of the structure 1006 is shaped and sized) to permit a toolsupport to slide through the guide such that movement of the toolsupport is constrained in all directions except along the axis definedby the guide.

As shown in FIG. 10A, a guide 1000, in some implementations, includes atubular structure 1006 (e.g., body), with a first longitudinal notch1022 a along its length and a second longitudinal notch 1022 b along itslength. In some implementations, the first notch 1022 a and second notch1022 b are located on opposite sides/portions of the body 1006 of theguide 1000 as shown in FIG. 10A. In some implementations, the guide 1000includes two or more notches that are spaced evenly (as shown in FIG.10A) or unevenly around the body of the guide.

In some implementations, the longitudinal notches 1022 a and 1022 b areslots. The longitudinal notches 1022 a-b, in some implementations, aresized in relation to one or more pegs (e.g., peg 420 as shown in FIG. 4)that couples a navigation marker to a tool support. As the tool supportslides through the guide 1000, one of the notches 1022 a-b permits thetool support to slide along the axis defined by the guide while theguide is held in a fixed position by the robotic surgical system. Thepeg extends through one of the notches 1022 a-b and outside of the guide1000 and permits the navigation marker attached to the tool support viathe peg to be viewed by a navigation camera along an entire range ofmovement of the tool support through the guide. In some implementations,the peg is utilized without the navigation marker to maintain theorientation of the surgical instrument. In some implementations, thenavigation marker is used by navigation camera to track the surgicalinstrument. The notches 1022 a-b may constrain movement of the marker ina fixed orientation along the axis defined by the guide. In someimplementations, longitudinal notches 1022 a-b are sized in relation toa peg to permit the surgical instrument to slide along the axis ofinsertion in reference to the tool support.

Among other things, incorporation of two or more notches, such asnotches 1022 a and 1022 b, permits for ambidextrous manipulation of theend effector and/or tool. Moreover, it permits positioning of therobotic surgical system on both sides of the operating room table.Furthermore, it permits positioning of the robotic surgical system onboth sides of the operating room table in reference to a navigationsystem (e.g., tracking camera).

In some implementations, the guide 1000 includes one or more inputdevices, such as electro-mechanical buttons. For example, the guide 100may include two electromechanical buttons 1008 a and 1008 b. In someimplementations, the guide 100 includes an activation switch 1060. Theactivation switch 1060 may be separate from the buttons 10086 a and 1008b. The activation switch 1060 may be a presence detection that can beused for enabling movements of the surgical robot. The types ofmovements may be defined by the buttons 1008 a and/or 1008 b. Thepresent detection may include a long button that is pressed when a usergrabs the handle (e.g., to thereby move the handle). In someimplementations, the activation switch detects the presence of a hand onthe handle.

In some implementations, a user may use the one or more input devices toselect to enter a translation mode, positioning mode, axis rotationmode, axis insertion mode and/or axis position mode. In someimplementations, the guide 1000 includes an enabling button, rotationbutton and/or a translation button. In some implementations, theenabling button must be selected with one or more other buttons toenable movement of the end effector. For example, to rotate the endeffector, the user may need to select the enabling button and therotation button. Similarly, to enable translations of the end effector,the user may need to select the enabling button and the translationsbutton. In some implementations, the end effector may enter a coursepositioning mode when a user selects the enabling button, translationsbutton, or rotations button. In some implementations, selection of theenabling button causes the robotic arm to enter the positioning mode inwhich the user is able to position the tool appropriately and allows theoperator to freely move the robotic arm (e.g., via course movements).

Selection of the translation mode allows, in some implementations, theend effector to be moved along a plane (e.g., a plan in line with theend of a tool such as a drill guide). An operator may use thetranslation mode to make fine movements with the end effector and tofind an entry point. Selection of the rotation mode locks movement ofthe end effector except rotations (e.g., the manipulator may only berotated). In some implementations, activation of the rotation modepermits an operator to make fine rotations around an entry point. Inaxis rotation mode an operator may rotate the end effector around aspecific axis (e.g., the axis formed by a drill guide). In axis positionmode, an operator may move the end effector without changing an axis(e.g., the axis formed by a drill guide). In axis insertion mode, anoperator may move the end effector along a trajectory.

The various positioning modes allow an operator to quickly andaccurately move the end effector to a desired position (e.g., on oralong a determined trajectory). When all of the buttons are released, insome implementations, the robot actively holds the position of the endeffector. For example, if a drill guide is coupled to the end effector,an operator may insert a drill into the drill guide without moving theposition of the end effector or drill guide. Thus, after carefullypositioning the drill guide along a desired trajectory, an operator mayaccurately drill along the desired trajectory.

FIG. 10B is an illustration of an example surgical instrument guide 1030with an intermediate lock 1032 to lock the position of the surgicalinstrument in the guiding tube 1006. Instead of having a long guidingtube, the robot may move the guiding tube 1006 along a trajectory (e.g.,in a straight line) thus creating a very long “virtual” guidance withoutcompromising haptic feedback for the surgeon. Additionally, theintermediate lock 1032 enables the surgical instrument to be placed inthe guiding tube prior to determining the correct trajectory. After thecorrect trajectory is determined, the robotic arm may be moved away fromthe patient such that, for example, the vertebrae may be accessed by asurgeon. After the vertebrae is prepared, the robot can assist thesurgeon in finding the right trajectory again, thus significantlydecreasing the time necessary for screw placement in comparison tomanual spinal surgeries.

An intermediate lock 1032 may be placed at an initial distance 1034,such as 80 mm, from an entry of the guiding tube 1006. In someimplementations, the initial distance is 80 mm. In some implementations,the initial distance is between 70-90 mm, 60-80 mm, or 80-100 mm. Insome implementations, the initial distance corresponds to the length ofthe longest pedicle screws used with a small amount of margin (e.g., 5,10, 15, or 20 mm of margin). In some implementations, the intermediatelock 1032 is a unidirectional lock that only blocks insertion movement.In some implementations, the initial distance 1034 is long enough toallow guidance of the inserted instrument when intermediate lock 1032 isin the locked position. For example, the initial distance, in someimplementations, is 30 mm. In some implementations, the initial distanceis between 25-25 mm, 20-40 mm, or 35-50 mm. In some implementations, theintermediate lock 1032 is a bidirectional lock that blocks insertion andremoval of the surgical instrument.

When the intermediate lock 1032 is released (e.g., unlocked), thesurgical instrument may be slide further into the guide. In someimplementations, the insertion distance 1036 (e.g., distance thesurgical instrument can move forward after the intermediate lock 1032 isreleased) is selected to allow sufficient guidance of the surgicalinstrument inside the vertebrae. In some implementations, the insertiondistance is 80 mm. In some implementations, the insertion distance isbetween 70-90 mm, 60-80 mm, or 80-100 mm. This may be defined by thetype of surgery and may be, for example, the length of a pedicle screwwith some margin (e.g., 40-80 mm of total travel; e.g., 55, 60, 65, 70,or 75 mm total). The intermediate lock 1032 may be implemented using avariety of mechanisms. The intermediate lock 1032 may be a spring lock(e.g., a button that is pressed through a hole on the guide by a springwhen the instrument is slide into a particular position). Theintermediate lock 1032 may be a small device that blocks the movement ofthe tool inside the guide 1006. For example, the intermediate lock 1032may block the peg (e.g., 420 as shown in FIG. 4) that holds a marker(e.g., 412 as shown in FIG. 4) to a tool support (e.g., 410 as shown inFIG. 4). The intermediate lock 1032 may be one or two bars that preventmovement of the instrument unilaterally or bilaterally, respectively.For example, two bars may be used to prevent the peg (e.g., 420 as shownin FIG. 4) from moving. In some implementations, a lock is provided tolock the surgical instrument in place when it is fully inserted in theguide 1006. The lock may be designed and/or function similarly to theintermediate lock.

FIG. 10C is an illustration of an example surgical instrument guide 1150with an end lock 1052 to lock the position of the surgical instrument inthe guiding tube 1006. The end lock may be used to prevent the surgicalinstrument from accidentally being removed from the guiding tube 1006.In some implementations, an instrument position sensor 1056 (e.g.,position detector) is integrated in the guiding tube 1006 (e.g., anyguiding tube described herein). The instrument position sensor 1056 maybe an inductive sensor, capacitive sensor, resistive sensor, mechanicalend switches, optical measuring device, force sensing device, or othersimilar position sensor. When the surgical instrument is inside the tube1006, the relative position of the instrument may be measured by theinstrument position sensor 1056. In some implementations, the sensor1056 detects discrete positions of the instrument inside the guidingtube 1006. For example, the sensor 1056 may detect when the surgicalinstrument is at a top, bottom, or middle position within the guide.

In some implementations, the robot generates movement of the tube 1006in response to the position of the instrument (e.g., to achieve movementalong a desired trajectory). The movement may be generated only when thesurgical instrument is at the extremities of the tube 1006 (e.g., ateither end of the notch 1022). The combination of these features and theability to combine movement of the instrument inside the guiding tube1006 and guidance of the tube 1006 by the robot to provides the abilityto obtain long and complicated trajectories using simple and shortsurgical instrument guide tubes (e.g., 1006) held by the robot.

The end lock 1052 may be a spring lock (e.g., a button that is pressedthrough a hole on the guide by a spring when the instrument is slideinto a particular position). The end lock 1052 may be a small devicethat blocks the movement of the tool inside the guide 1006. For example,the end lock 1052 may block the peg (e.g., 420 as shown in FIG. 4) thatholds a marker (e.g., 412 as shown in FIG. 4) to a tool support (e.g.,410 as shown in FIG. 4). The end lock 1052 may be one or two bars thatprevent movement of the instrument unilaterally or bilaterally,respectively. For example, two bars may be used to prevent the peg(e.g., 420 as shown in FIG. 4) from moving.

FIG. 11 is an illustration of an example surgical instrument guide 1100for use with a robotic surgical system. Guide 1100, in someimplementations, includes a rectangular or square structure 1106 (e.g.,body), with a longitudinal notch 1108 along its length. In someimplementations, the longitudinal notch 1108 is a slot. Other shapedbridges may be used as well, such as hexagonal, trapezoidal, ortriangular bodies. The longitudinal notch 1008 is sized in relation to abase 1104 that couples, for example, a tool support 1106. As the base1104 slides through the guide body 1102, the notch 1108 permits the toolsupport to slide along the axis defined by the guide while the guide isheld in a fixed position by the robotic surgical system. The toolsupport 1106, in some implementations, is coupled to the base 1104 viaan arm 1110 (e.g., peg). The arm 1110 extends through an opening in thenotch 1108 and outside of the guide 1100 and permits, for example, thenavigation marker attached to the tool support via the arm 1110 to beviewed by a navigation camera along an entire range of movement of thetool support through the guide. In some implementations, the navigationmarker is used by navigation camera to track the surgical instrument.The notch 1108 may constrain movement of the marker in a fixedorientation along the axis defined by the guide. In someimplementations, longitudinal notch 1108 is sized in relation to a pegto permit the surgical instrument to slide along the axis of insertionin reference to the tool support.

FIG. 12 is a flowchart of an example method 1200 for performing surgerywith a robotic surgical system. The method 1200 may include opening thepatient and obtaining access to a vertebra (1202). A patient marker maybe attached to the patient in a fixed position (1204) such that anymovements of the vertebra may be tracked and compensated for by therobot. The patient may be registered (1206). Patient registration may beaccomplished while obtaining intra-operative patient images using 3Dfluoroscopy.

The method 1200 may include moving a mobile cart transporting a roboticsurgical system comprising a robotic arm in proximity to an operatingtable and stabilizing the mobile cart (1208). A first surgicalinstrument may be inserted into the guiding tube until locked in placeby the intermediate lock (1210). This allows the robotic arm to be movedwhile holding the surgical instrument in place. In some implementations,the lock restricts the instrument from being slide past a presentposition. In some implementations, the lock prevents the instrument frombeing removed. Various embodiments of the lock are discussed in relationto FIGS. 10B and 10C.

After inserting the surgical instrument, the trajectory may be located(1212). Once the trajectory is located, the instrument may be advancedalong the trajectory using robot control (1214). The intermediate lockmay be released and the robot may be placed in a holding position modesuch that movement of the instrument is restricted along the trajectory,thus allowing a surgeon to manually prepare a hole for a screw (1216).After preparing the hole, the first surgical instrument may be removedfrom the guidance tube (1218). A second surgical instrument may beinserted after the first instrument is removed. In some implementations,before placing an implant, the user may tap the hole. In someimplementations, a self-tapping screw is used directly without drilling.An implant may be inserted through the guiding tube and fixed to thepatient anatomy (1220). After fixing the implant to the patient anatomy,the surgeon may move to another trajectory (1222).

FIG. 13 is a flowchart of an example of a method 1300 for performing aminimally invasive surgery using a robotic surgical system as a drillguide. A patient marker may be attached to the patient in a fixedposition (1302) such that any movements of the vertebra may be trackedand compensated for by the robot. The patient may be registered (1304).Patient registration may be accomplished while obtaining intra-operativepatient images using 3D fluoroscopy.

The method 1300 may include moving a mobile cart transporting a roboticsurgical system comprising a robotic arm in proximity to an operatingtable and stabilizing the mobile cart (1306). A first surgicalinstrument may be inserted into the guiding tube until locked in placeby the intermediate lock (1308). This allows the robotic arm to be movedwhile holding the surgical instrument in place. In some implementations,the lock restricts the instrument from being slide past a presentposition. In some implementations, the lock prevents the instrument frombeing removed. Various embodiments of the lock are discussed in relationto FIGS. 10B and 10C.

After inserting the surgical instrument, the trajectory may be locatedand saved (1310). After saving the trajectory, the vertebra may bemanually accessed (1312). The surgical instrument may be brought back tothe trajectory (1314). This may be done manually by the surgeon. In someimplementations, the surgeon may be assisted and/or guided by the robotto ensure that the instrument is returned to the correct trajectory. Forexample, an example assistance is the use of a “magnetic” effect whichdrags the instrument to the correct trajectory and locks it when it ison the correct trajectory.

After aligning the instrument with the trajectory, the instrument may beadvanced along the trajectory (1316). The intermediate lock may bereleased and the robot may be placed in a holding position mode suchthat movement of the instrument is restricted along the trajectory, thusallowing a surgeon to manually prepare a hole for a screw (1318). Afterpreparing the hole, the first surgical instrument may be removed fromthe guidance tube (1320). A second surgical instrument may be insertedafter the first instrument is removed. An implant may be insertedthrough the guiding tube and fixed to the patient anatomy (1322). Afterfixing the implant to the patient anatomy, the surgeon may move toanother trajectory (1324).

As shown in FIG. 14, an implementation of a network environment 1400 foruse with a robotic surgical system is shown and described. In briefoverview, referring now to FIG. 14, a block diagram of an exemplarycloud computing environment 1400 is shown and described. The cloudcomputing environment 1400 may include one or more resource providers1402 a, 1402 b, 1402 c (collectively, 1402). Each resource provider 1402may include computing resources. In some implementations, computingresources may include any hardware and/or software used to process data.For example, computing resources may include hardware and/or softwarecapable of executing algorithms, computer programs, and/or computerapplications. In some implementations, exemplary computing resources mayinclude application servers and/or databases with storage and retrievalcapabilities. Each resource provider 1402 may be connected to any otherresource provider 1402 in the cloud computing environment 1400. In someimplementations, the resource providers 1402 may be connected over acomputer network 1408. Each resource provider 1402 may be connected toone or more computing device 1404 a, 1404 b, 1404 c (collectively,1404), over the computer network 1408.

The cloud computing environment 1400 may include a resource manager1406. The resource manager 1406 may be connected to the resourceproviders 1402 and the computing devices 1404 over the computer network1408. In some implementations, the resource manager 1406 may facilitatethe provision of computing resources by one or more resource providers1402 to one or more computing devices 1404. The resource manager 1406may receive a request for a computing resource from a particularcomputing device 1404. The resource manager 1406 may identify one ormore resource providers 1402 capable of providing the computing resourcerequested by the computing device 1404. The resource manager 1406 mayselect a resource provider 1402 to provide the computing resource. Theresource manager 1406 may facilitate a connection between the resourceprovider 1402 and a particular computing device 1404. In someimplementations, the resource manager 1406 may establish a connectionbetween a particular resource provider 1402 and a particular computingdevice 1404. In some implementations, the resource manager 1406 mayredirect a particular computing device 1404 to a particular resourceprovider 1402 with the requested computing resource.

FIG. 15 shows an example of a computing device 1500 and a mobilecomputing device 1550 that can be used to implement the techniquesdescribed in this disclosure. The computing device 1500 is intended torepresent various forms of digital computers, such as laptops, desktops,workstations, personal digital assistants, servers, blade servers,mainframes, and other appropriate computers. The mobile computing device1550 is intended to represent various forms of mobile devices, such aspersonal digital assistants, cellular telephones, smart-phones, andother similar computing devices. The components shown here, theirconnections and relationships, and their functions, are meant to beexamples only, and are not meant to be limiting.

The computing device 1500 includes a processor 1502, a memory 1504, astorage device 1506, a high-speed interface 1508 connecting to thememory 1504 and multiple high-speed expansion ports 1510, and alow-speed interface 1512 connecting to a low-speed expansion port 1514and the storage device 1506. Each of the processor 1502, the memory1504, the storage device 1506, the high-speed interface 1508, thehigh-speed expansion ports 1510, and the low-speed interface 1512, areinterconnected using various busses, and may be mounted on a commonmotherboard or in other manners as appropriate. The processor 1502 canprocess instructions for execution within the computing device 1500,including instructions stored in the memory 1504 or on the storagedevice 1506 to display graphical information for a GUI on an externalinput/output device, such as a display 1516 coupled to the high-speedinterface 1508. In other implementations, multiple processors and/ormultiple buses may be used, as appropriate, along with multiple memoriesand types of memory. Also, multiple computing devices may be connected,with each device providing portions of the necessary operations (e.g.,as a server bank, a group of blade servers, or a multi-processorsystem).

The memory 1504 stores information within the computing device 1500. Insome implementations, the memory 1504 is a volatile memory unit orunits. In some implementations, the memory 1504 is a non-volatile memoryunit or units. The memory 1504 may also be another form ofcomputer-readable medium, such as a magnetic or optical disk.

The storage device 1506 is capable of providing mass storage for thecomputing device 1500. In some implementations, the storage device 1506may be or contain a computer-readable medium, such as a floppy diskdevice, a hard disk device, an optical disk device, or a tape device, aflash memory or other similar solid state memory device, or an array ofdevices, including devices in a storage area network or otherconfigurations. Instructions can be stored in an information carrier.The instructions, when executed by one or more processing devices (forexample, processor 1502), perform one or more methods, such as thosedescribed above. The instructions can also be stored by one or morestorage devices such as computer- or machine-readable mediums (forexample, the memory 1504, the storage device 1506, or memory on theprocessor 1502).

The high-speed interface 1508 manages bandwidth-intensive operations forthe computing device 1500, while the low-speed interface 1512 manageslower bandwidth-intensive operations. Such allocation of functions is anexample only. In some implementations, the high-speed interface 1508 iscoupled to the memory 1504, the display 1516 (e.g., through a graphicsprocessor or accelerator), and to the high-speed expansion ports 1510,which may accept various expansion cards (not shown). In theimplementation, the low-speed interface 1512 is coupled to the storagedevice 1506 and the low-speed expansion port 1514. The low-speedexpansion port 1514, which may include various communication ports(e.g., USB, Bluetooth®, Ethernet, wireless Ethernet) may be coupled toone or more input/output devices, such as a keyboard, a pointing device,a scanner, or a networking device such as a switch or router, e.g.,through a network adapter.

The computing device 1500 may be implemented in a number of differentforms, as shown in the figure. For example, it may be implemented as astandard server 1520, or multiple times in a group of such servers. Inaddition, it may be implemented in a personal computer such as a laptopcomputer 1522. It may also be implemented as part of a rack serversystem 1524. Alternatively, components from the computing device 1500may be combined with other components in a mobile device (not shown),such as a mobile computing device 1550. Each of such devices may containone or more of the computing device 1500 and the mobile computing device1550, and an entire system may be made up of multiple computing devicescommunicating with each other.

The mobile computing device 1550 includes a processor 1552, a memory1564, an input/output device such as a display 1554, a communicationinterface 1566, and a transceiver 1568, among other components. Themobile computing device 1550 may also be provided with a storage device,such as a micro-drive or other device, to provide additional storage.Each of the processor 1552, the memory 1564, the display 1554, thecommunication interface 1566, and the transceiver 1568, areinterconnected using various buses, and several of the components may bemounted on a common motherboard or in other manners as appropriate.

The processor 1552 can execute instructions within the mobile computingdevice 1550, including instructions stored in the memory 1564. Theprocessor 1552 may be implemented as a chipset of chips that includeseparate and multiple analog and digital processors. The processor 1552may provide, for example, for coordination of the other components ofthe mobile computing device 1550, such as control of user interfaces,applications run by the mobile computing device 1550, and wirelesscommunication by the mobile computing device 1550.

The processor 1552 may communicate with a user through a controlinterface 1558 and a display interface 1556 coupled to the display 1554.The display 1554 may be, for example, a TFT (Thin-Film-Transistor LiquidCrystal Display) display or an OLED (Organic Light Emitting Diode)display, or other appropriate display technology. The display interface1556 may comprise appropriate circuitry for driving the display 1554 topresent graphical and other information to a user. The control interface1558 may receive commands from a user and convert them for submission tothe processor 1552. In addition, an external interface 1562 may providecommunication with the processor 1552, so as to enable near areacommunication of the mobile computing device 1550 with other devices.The external interface 1562 may provide, for example, for wiredcommunication in some implementations, or for wireless communication inother implementations, and multiple interfaces may also be used.

The memory 1564 stores information within the mobile computing device1550. The memory 1564 can be implemented as one or more of acomputer-readable medium or media, a volatile memory unit or units, or anon-volatile memory unit or units. An expansion memory 1574 may also beprovided and connected to the mobile computing device 1550 through anexpansion interface 1572, which may include, for example, a SIMM (SingleIn Line Memory Module) card interface. The expansion memory 1574 mayprovide extra storage space for the mobile computing device 1550, or mayalso store applications or other information for the mobile computingdevice 1550. Specifically, the expansion memory 1574 may includeinstructions to carry out or supplement the processes described above,and may include secure information also. Thus, for example, theexpansion memory 1574 may be provided as a security module for themobile computing device 1550, and may be programmed with instructionsthat permit secure use of the mobile computing device 1550. In addition,secure applications may be provided via the SIMM cards, along withadditional information, such as placing identifying information on theSIMM card in a non-hackable manner.

The memory may include, for example, flash memory and/or NVRAM memory(non-volatile random access memory), as discussed below. In someimplementations, instructions are stored in an information carrier and,when executed by one or more processing devices (for example, processor1552), perform one or more methods, such as those described above. Theinstructions can also be stored by one or more storage devices, such asone or more computer- or machine-readable mediums (for example, thememory 1564, the expansion memory 1574, or memory on the processor1552). In some implementations, the instructions can be received in apropagated signal, for example, over the transceiver 1568 or theexternal interface 1562.

The mobile computing device 1550 may communicate wirelessly through thecommunication interface 1566, which may include digital signalprocessing circuitry where necessary. The communication interface 1566may provide for communications under various modes or protocols, such asGSM voice calls (Global System for Mobile communications), SMS (ShortMessage Service), EMS (Enhanced Messaging Service), or MMS messaging(Multimedia Messaging Service), CDMA (code division multiple access),TDMA (time division multiple access), PDC (Personal Digital Cellular),WCDMA (Wideband Code Division Multiple Access), CDMA2000, or GPRS(General Packet Radio Service), among others. Such communication mayoccur, for example, through the transceiver 1568 using aradio-frequency. In addition, short-range communication may occur, suchas using a Bluetooth®, Wi-Fi™, or other such transceiver (not shown). Inaddition, a GPS (Global Positioning System) receiver module 1570 mayprovide additional navigation- and location-related wireless data to themobile computing device 1550, which may be used as appropriate byapplications running on the mobile computing device 1550.

The mobile computing device 1550 may also communicate audibly using anaudio codec 1560, which may receive spoken information from a user andconvert it to usable digital information. The audio codec 1560 maylikewise generate audible sound for a user, such as through a speaker,e.g., in a handset of the mobile computing device 1550. Such sound mayinclude sound from voice telephone calls, may include recorded sound(e.g., voice messages, music files, etc.) and may also include soundgenerated by applications operating on the mobile computing device 1550.

The mobile computing device 1550 may be implemented in a number ofdifferent forms, as shown in the figure. For example, it may beimplemented as a cellular telephone 1580. It may also be implemented aspart of a smart-phone 1582, personal digital assistant, or other similarmobile device.

Various implementations of the systems and techniques described here canbe realized in digital electronic circuitry, integrated circuitry,specially designed ASICs (application specific integrated circuits),computer hardware, firmware, software, and/or combinations thereof.These various implementations can include implementation in one or morecomputer programs that are executable and/or interpretable on aprogrammable system including at least one programmable processor, whichmay be special or general purpose, coupled to receive data andinstructions from, and to transmit data and instructions to, a storagesystem, at least one input device, and at least one output device.

These computer programs (also known as programs, software, softwareapplications or code) include machine instructions for a programmableprocessor, and can be implemented in a high-level procedural and/orobject-oriented programming language, and/or in assembly/machinelanguage. As used herein, the terms machine-readable medium andcomputer-readable medium refer to any computer program product,apparatus and/or device (e.g., magnetic discs, optical disks, memory,Programmable Logic Devices (PLDs)) used to provide machine instructionsand/or data to a programmable processor, including a machine-readablemedium that receives machine instructions as a machine-readable signal.The term machine-readable signal refers to any signal used to providemachine instructions and/or data to a programmable processor.

To provide for interaction with a user, the systems and techniquesdescribed here can be implemented on a computer having a display device(e.g., a CRT (cathode ray tube) or LCD (liquid crystal display) monitor)for displaying information to the user and a keyboard and a pointingdevice (e.g., a mouse or a trackball) by which the user can provideinput to the computer. Other kinds of devices can be used to provide forinteraction with a user as well; for example, feedback provided to theuser can be any form of sensory feedback (e.g., visual feedback,auditory feedback, or tactile feedback); and input from the user can bereceived in any form, including acoustic, speech, or tactile input.

The systems and techniques described here can be implemented in acomputing system that includes a back end component (e.g., as a dataserver), or that includes a middleware component (e.g., an applicationserver), or that includes a front end component (e.g., a client computerhaving a graphical user interface or a Web browser through which a usercan interact with an implementation of the systems and techniquesdescribed here), or any combination of such back end, middleware, orfront end components. The components of the system can be interconnectedby any form or medium of digital data communication (e.g., acommunication network). Examples of communication networks include alocal area network (LAN), a wide area network (WAN), and the Internet.

The computing system can include clients and servers. A client andserver are generally remote from each other and typically interactthrough a communication network. The relationship of client and serverarises by virtue of computer programs running on the respectivecomputers and having a client-server relationship to each other.

In view of the structure, functions and apparatus of the systems andmethods described here, in some implementations, a system and method forperforming surgery with a robotic surgical system are provided. Havingdescribed certain implementations of methods and apparatus forsupporting a robotic surgical system, it will now become apparent to oneof skill in the art that other implementations incorporating theconcepts of the disclosure may be used. Therefore, the disclosure shouldnot be limited to certain implementations, but rather should be limitedonly by the spirit and scope of the following claims.

Throughout the description, where apparatus and systems are described ashaving, including, or comprising specific components, or where processesand methods are described as having, including, or comprising specificsteps, it is contemplated that, additionally, there are apparatus, andsystems of the disclosed technology that consist essentially of, orconsist of, the recited components, and that there are processes andmethods according to the disclosed technology that consist essentiallyof, or consist of, the recited processing steps.

It should be understood that the order of steps or order for performingcertain action is immaterial so long as the disclosed technology remainsoperable. Moreover, two or more steps or actions may be conductedsimultaneously.

What is claimed:
 1. A surgical instrument guide for use with a roboticsurgical system, the surgical instrument guide comprising a rigid hollowtubular structure having a first open end and a second open end, saidstructure defining an axis along which movement of a surgical instrumentin the structure is restricted, wherein the tubular structure comprises:an interior surface shaped and sized to accommodate the surgicalinstrument in the surgical instrument guide such that movement of thesurgical instrument is constrained in at least one direction; alongitudinal notch in a side of the rigid hollow tubular structure,wherein the longitudinal notch is sized in relation to a peg to (i)permit a navigation marker attached to the surgical instrument via thepeg to be viewable by a navigation camera, and (ii) constrain movementalong the axis to a translational range defined by a distance betweenthe lock and the terminal end.
 2. The surgical instrument guide of claim1, wherein the rigid hollow tubular structure is a cylindricalstructure.
 3. The surgical instrument guide of claim 1, wherein thelongitudinal notch is a slot.
 4. The surgical instrument guide of claim1, wherein the navigation marker is used by navigation camera to trackthe surgical instrument.
 5. The surgical instrument guide of claim 1,wherein the notch is sized in relation to a peg to permit the surgicalinstrument to slide along the axis.
 6. The surgical instrument guide ofclaim 1, wherein the tubular structure comprises a second longitudinalnotch extending from the first open end of the rigid hollow tubularstructure, the second longitudinal notch having a terminal end thatlimits insertion of the surgical instrument.
 7. The surgical instrumentguide of claim 6, wherein the second longitudinal notch is sized inrelation to a peg to (i) permit a navigation marker attached to thesurgical instrument via the peg to be viewable by a navigation camera,(ii) constrain movement of the marker to along the axis.
 8. The surgicalinstrument guide of claim 1, wherein the lock, when engaged, preventsmovement of a surgical instrument within the rigid hollow tubularstructure beyond a preset position along the axis defined by thesurgical instrument guide.
 9. The surgical instrument guide of claim 1,wherein the lock, when engaged, prevents removal of a surgicalinstrument from the surgical instrument guide.
 10. The surgicalinstrument guide of claim 9, wherein the lock is an end lock.
 11. Thesurgical instrument guide of claim 1, comprising an intermediate lockthat, when engaged, prevents movement of a surgical instrument withinthe rigid hollow tubular structure beyond a preset position along theaxis.
 12. The surgical instrument guide of claim 1, comprising aninstrument position sensor that detects the position of a surgicalinstrument when the surgical instrument is in and/or attached to therigid hollow tubular structure.
 13. The surgical instrument guide ofclaim 12, wherein the instrument position sensor detects when thesurgical instrument is at the bottom position within the surgicalinstrument guide.
 14. The surgical instrument guide of claim 12, whereinthe instrument position sensor detects when the surgical instrument isat the bottom position within the surgical instrument guide such thatrobot generates movement of the surgical instrument guide along adesired trajectory.
 15. The surgical instrument guide of claim 12,wherein the instrument position sensor is selected from the groupconsisting of: an inductive sensor, a capacitive sensor, a resistivesensor, a mechanical end switch, an optical measuring device, a forcesensing device, and a position sensor.
 16. The surgical instrument guideof claim 1, comprising: one or more input devices.
 17. The surgicalinstrument guide of claim 1, comprising: an activation switch thatdetects the presence of a surgeon's hand on the surgical instrumentguide.
 18. The surgical instrument guide of claim 1, wherein said atleast one direction comprises all directions except along the axisdefined by the surgical instrument guide.
 19. The surgical instrumentguide of claim 1, wherein the interior surface of the tubular structureis shaped and sized to accommodate the surgical instrument slidingthrough the surgical instrument guide.
 20. The surgical instrument guideof claim 1, wherein the surgical instrument guide comprises two or morerails that restrict movement of a surgical instrument in the structurealong the axis.
 21. The surgical instrument guide of claim 1, whereinthe tubular structure comprises: an exterior surface comprising at leastone flange that is configured for secure coupling of the surgicalinstrument guide to an end effector of the robotic surgical system. 22.The surgical instrument guide of claim 1, wherein the longitudinal notchprevents rotation of the surgical instrument about the axis when thesurgical instrument is inserted.
 23. The surgical instrument guide ofclaim 21, wherein the at least one flange comprises one or more holesfor bolting the surgical instrument guide to the end effector.